For the last 50 years, antireflux treatments have been directed at the neutralization or suppression of stomach acid. Antacids (e.g., Mylanta, Gaviscon), H2-antagonists (e.g., Zantac, Pepcid), and proton pump inhibitors (e.g., Prilosec, Nexium) are among the leading-selling drugs in the world.
The term “reflux” means “backflow.” The backflow of stomach (gastric) contents into the esophagus is known as gastroesophageal reflux disease (GERD). In the last decade, the backflow of stomach contents into the upper aerodigestive (airway and digestive) tract has become increasingly recognized as an important factor in the development of many common diseases. The medical terms for this are laryngopharyngeal reflux (LPR) and extra-esophageal reflux (EER). Both terms are commonly used; however, EER is the broader of the two terms. The laryngopharynx includes the voice box as well as the pharynx (the upper and lower parts of the throat); however, EER also refers to gastric reflux into any part of the aerodigestive tract, including the uppermost parts of the airway and digestive tracts, e.g., the mouth, oropharynx, nasopharynx, nose, and sinuses.
EER is different in many ways from GERD. What makes EER particularly important and insidious is the fact that it can be “silent,” that is, it can occur without any digestive symptoms such as heartburn (reflux-related chest pain). Both EER and GERD are associated with the development of many common aerodigestive tract diseases, including esophagitis, esophageal cancer, pharyngitis, laryngitis, sinusitis, and chronic lung diseases such as asthma.
Scientific studies have shown that gastric juice, referred to as the refluxate, has two ingredients, acid and pepsin. Pepsin is the primary digestive enzyme of the stomach. Contrary to popular belief, it is pepsin, not acid, that produces disease.
When gastric liquid containing acid and pepsin finds its way back up into the throat area (which should not happen but does on occasion) the lining membranes of the throat try to increase protective mucus production. However, this response is usually insufficient to protect against the acid and pepsin.
In the throat and respiratory tract area, active pepsin can bind to the tissue where it can cause many symptoms and even serious tissue damage over a period of time. This can range from a sore throat to cancer and death. Pepsin actually attacks and takes apart the surface of the cells of the lining membranes leaving them exposed to germs. If fact, active pepsin alone can cause the death of otherwise healthy throat lining membranes.
Thus, a need presently exists for a method for prevention and treatment of reflux injury in the laryngopharynx caused by pepsin. A need also exists for an apparatus for orally dispensing a composition, such as a powdered composition, into the aerodigestive tract in general, and specifically into the laryngopharynx.